Erythrocyte Sedimentation Rate (ESR) - Understand the Test & Your Results

What is an Erythrocyte Sedimentation Rate (ESR)?
An erythrocyte sedimentation rate (ESR) is a blood test that that can show if you have inflammation in your body. Inflammation is your immune system's response to injury, infection, and many types of conditions, including immune system disorders , certain cancers , and blood disorders .
Erythrocytes are red blood cells. To do an ESR test, a sample of your blood is sent to a lab. A health care professional places the sample in a tall, thin test tube and measures how quickly the red blood cells settle or sink to the bottom of the tube. Normally, red blood cells sink slowly. But inflammation makes red blood cells stick together in clumps. These clumps of cells are heavier than single cells, so they sink faster.
If an ESR test shows that your red blood cells sink faster than normal, it may mean you have a medical condition causing inflammation. The speed of your test result is a sign of how much inflammation you have. Faster ESR rates mean higher levels of inflammation. But an ESR test alone cannot diagnose what condition is causing the inflammation.
Other names: ESR, SED rate sedimentation rate; Westergren sedimentation rate
What is it used for?
An ESR test can be used with other tests to help diagnose conditions that cause inflammation. It can also be used to help monitor these conditions. Many types of conditions cause inflammation, including arthritis , vasculitis , infection, and inflammatory bowel disease. An ESR may also be used to monitor an existing condition.
Why do I need an ESR?
Your health care provider may order an ESR if you have symptoms of a condition that causes inflammation. Your symptoms will depend on the condition you may have, but they may include:
Headaches
Unexplained fever
Weight loss
Joint stiffness
Neck or shoulder pain
Loss of appetite
Anemia
What happens during an ESR?
A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
Will I need to do anything to prepare for an ESR?
You don't need any special preparations for this test. But if your provider ordered other tests on your blood sample, you may need to fast (not eat or drink) for several hours before the test. Your provider will let you know if there are any special instructions to follow.
Are there any risks to the test?
There is very little risk to having an ESR. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.
What do the results mean?
Your provider will use the results of your ESR test along with your medical history, symptoms, and other test results to make a diagnosis. An ESR test alone cannot diagnose conditions that cause inflammation.
A high ESR test result may be from a condition that causes inflammation, such as:
Arteritis
Arthritis
Systemic vasculitis
Polymyalgia rheumatica
Inflammatory bowel disease
Kidney disease
Infection
Rheumatoid arthritis and other autoimmune diseases
Heart disease
Certain cancers
A low ESR test result means your red blood cells sank more slowly than normal. This may be caused by conditions such as:
A blood disorder, such as:
Polycythemia
Sickle cell disease (SCD)
Leukocytosis, a very high white blood cell count (WBC)
Heart failure
Certain kidney and liver problems
If your ESR results are not normal, it doesn't always mean you have a medical condition that needs treatment. Pregnancy , a menstrual cycle , aging, obesity , drinking alcohol regularly, and exercise can affect ESR results. Certain medicines and supplements may also affect your results, so be sure to tell your provider about any medicines or supplements you are taking.
Learn more about laboratory tests, reference ranges, and understanding results .
Is there anything else I need to know about an ESR?
Because an ESR can't diagnose a specific disease, your provider may order other tests at the same time. Also, it's possible to have a condition that causes inflammation and still have a normal ESR result. A C-reactive protein (CRP) test is commonly done with an ESR to provide more information.
References
Cleveland Clinic: Health Library: Diagnostics & Testing [Internet]. Cleveland (OH): Cleveland Clinic; c2022. Sed Rate (Erythrocyte Sedimentation Rate or ESR) Test; [reviewed 2018 Mar 14; cited 2022 Mar 17]; [about 5 screens]. Available from: https://my.clevelandclinic.org/health/diagnostics/17747-sed-rate-erythrocyte-sedimentation-rate-or-esr-test
Hinkle J, Cheever K. Brunner & Suddarth's Handbook of Laboratory and Diagnostic Tests. 2nd Ed, Kindle. Philadelphia: Wolters Kluwer Health, Lippincott Williams & Wilkins; c2014. Erythrocyte Sedimentation Rate (ESR); p. 267-68.
MDS Manual Consumer Version [Internet]. Kenilworth (NJ): Merck & Co., Inc.; c2022. Lab Test: Erythrocyte Sedimentation Rate (ESR); [reviewed 2020 May; cited 2022 Feb 18]; [about 2 screens]. Available from: https://www.msdmanuals.com/en-pt/home/SearchResults?query=erythrocyte+sedimentation+rate#
National Heart, Lung, and Blood Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Blood Tests; [ cited 2022 Mar 17]; [about 16 screens]. Available from: https://www.nhlbi.nih.gov/health-topics/blood-tests
Testing.com [Internet]. Seattle (WA): OneCare Media; c2022. Erythrocyte Sedimentation Rate (ESR); [modified 2022 Jan 14; cited 2022 Mar 17]; [about 10 screens]. Available from: https://www.testing.com/tests/erythrocyte-sedimentation-rate-esr/
Tishkowski K, Gupta V. Erythrocyte Sedimentation Rate. [Updated 2021 May 9; cited 2022 Mar 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557485/
University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; c2022. Health Encyclopedia: Erythrocyte Sedimentation Rate; [cited 2022 Mar 17]; [about 4 screens]. Available from: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=erythrocyte_sedimentation_rate